Bill Summary
The resolution expresses the House of Representatives' disapproval of the proposed Wasteful and Inappropriate Services Reduction (WISeR) Model, which is set to begin on January 1, 2026. This model aims to increase the number of services in traditional Medicare that require prior authorization by 30%, contracting with private companies that currently manage these processes for Medicare Advantage plans. Advocates argue that prior authorization can hinder patient access to necessary healthcare, adding to physician burnout and resulting in high rates of incorrect decisions by these private companies. The resolution highlights concerns about the potential negative impact on beneficiary access to timely medical care and calls for the termination of the WISeR Model by the Centers for Medicare and Medicaid Services.
Possible Impacts
The proposed Wasteful and Inappropriate Service Reduction (WISeR) Model, as expressed in the resolution, could affect people in the following ways:
1. **Increased Delays in Access to Care**: By expanding the number of services requiring prior authorization by 30%, beneficiaries may experience longer wait times for necessary medical treatments and services. This could lead to deteriorating health conditions for patients who cannot afford to delay their care or who require timely interventions.
2. **Higher Rates of Denied Services**: The model's reliance on private companies for prior authorization processes, which have historically shown high rates of incorrect denial (as indicated by the 81.7% overturn rate for appeals), could result in more beneficiaries facing denials for essential medical services. This may lead to frustration and confusion among patients who depend on Medicare for their healthcare needs.
3. **Increased Physician Burnout and Reduced Quality of Care**: With 89% of physicians reporting that prior authorization contributes to their burnout, the implementation of the WISeR Model could exacerbate this issue, potentially leading to a decrease in physician satisfaction and an increased likelihood of physicians leaving the profession. This could ultimately affect the quality of care that patients receive, as overworked and stressed physicians may not be able to provide the level of attention and care that patients require.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H. Res. 704 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. RES. 704
Expressing the sense of the House of Representatives that the Wasteful
and Inappropriate Service Reduction Model undermines beneficiary access
to health care and should not be implemented.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 11, 2025
Mr. Pocan (for himself, Ms. Schakowsky, Mr. Doggett, Ms. Ocasio-Cortez,
Ms. Tlaib, Mrs. Watson Coleman, Mr. Landsman, and Ms. Goodlander)
submitted the following resolution; which was referred to the Committee
on Ways and Means, and in addition to the Committee on Energy and
Commerce, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the
jurisdiction of the committee concerned
_______________________________________________________________________
RESOLUTION
Expressing the sense of the House of Representatives that the Wasteful
and Inappropriate Service Reduction Model undermines beneficiary access
to health care and should not be implemented.
Whereas the Center for Medicare and Medicaid Innovation proposed a program
called the Wasteful and Inappropriate Services Reduction (WISeR) Model
to commence on January 1, 2026;
Whereas the WISeR Model proposes to increase the number of services that require
prior authorization in traditional Medicare by 30 percent;
Whereas the WISeR Model proposes to contract with private companies that are
currently administering prior authorization processes for private
insurance companies, including Medicare Advantage companies;
Whereas the WISeR Model proposes to use enhanced technologies, including
artificial intelligence and machine learning, to process the expanded
prior authorizations in traditional Medicare;
Whereas prior authorization has become an obstacle to needed medical care for
patients;
Whereas, according to the American Medical Association, 89 percent of physicians
report that prior authorization contributes to physician burnout;
Whereas, according to the Medicare Limited Data Set published by the Centers for
Medicare and Medicaid Services, private companies targeted for
participation in this model have a demonstrated record of incorrect
decisions on prior authorization requests, are 81.7 percent of denials
made by Medicare Advantage insurers overturned once appealed, according
to the Kaiser Family Foundation; and
Whereas, according to an article in Fierce Healthcare, tools using artificial
intelligence to review coverage decisions developed by private health
insurance companies, like those targeted for participation in the WISeR
model, are reported to have 90 percent error rates: Now, therefore, be
it
Resolved, That the House of Representatives--
(1) expresses disapproval of the Wasteful and Inappropriate
Service Reduction (WISeR) Model;
(2) finds that expanding prior authorization processes used
in Medicare Advantage into the publicly administered
traditional Medicare Program undermines beneficiary access to
timely and necessary medical care; and
(3) strongly requests that the Centers for Medicare and
Medicaid Services terminate the WISeR Model.
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